| Source HCPCS Code |
|
Target NDC Code |
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
00173-0995-01
ZOVIRAX 500 MG
|
| Detail Information |
| Relationship Start Date |
1/1/2006 |
| Relationship End Date |
4/18/2006 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
38779-0173-01
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
38779-0173-04
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
38779-0173-05
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
38779-0173-08
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
49452-0001-03
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
6/1/2015 |
| Relationship End Date |
10/17/2016 |
| Number Of Items In Ndc Package |
25 |
| Ndc Package Measure |
GM |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
49452-0001-04
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
09/01/2015 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
GM |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
51552-0671-01
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
51552-0671-02
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
51552-0671-03
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
51552-0671-04
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
51552-0671-05
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
51552-0671-06
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
51927-2994-00
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
|
⇄
|
54569-5173-00
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0133
Injection, acyclovir, 5 mg
|
⇄
|
55150-0154-10
ACYCLOVIR 500 MG/10 ML VIAL
|
| Detail Information |
| Relationship Start Date |
02/20/2014 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0133
Injection, acyclovir, 5 mg
|
⇄
|
55150-0155-20
ACYCLOVIR 1,000 MG/20 ML VIAL
|
| Detail Information |
| Relationship Start Date |
02/20/2014 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
55390-0612-10
ACYCLOVIR SODIUM (PF) 500 MG
|
| Detail Information |
| Relationship Start Date |
1/1/2006 |
| Relationship End Date |
|
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
55390-0613-20
ACYCLOVIR SODIUM (PF) 1000 MG
|
| Detail Information |
| Relationship Start Date |
1/1/2006 |
| Relationship End Date |
|
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
61703-0311-21
ACYCLOVIR SODIUM (VIAL) 25 MG/ML
|
| Detail Information |
| Relationship Start Date |
1/1/2006 |
| Relationship End Date |
4/24/2006 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
61703-0311-43
ACYCLOVIR SODIUM (VIAL) 25 MG/ML
|
| Detail Information |
| Relationship Start Date |
1/1/2006 |
| Relationship End Date |
4/24/2006 |
| Number Of Items In Ndc Package |
40 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
62991-1004-01
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
62991-1004-02
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
63323-0105-10
ACYCLOVIR SODIUM (VIAL,PF) 500 MG
|
| Detail Information |
| Relationship Start Date |
1/1/2006 |
| Relationship End Date |
|
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0133
Injection, acyclovir, 5 mg
|
⇄
|
63323-0325-03
ACYCLOVIR 500 MG/10 ML VIAL
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
05/22/2026 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
Injection, acyclovir, 5 mg
|
⇄
|
63323-0325-09
ACYCLOVIR 1,000 MG/20 ML VI
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
06/17/2026 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
63323-0325-10
ACYCLOVIR SODIUM (S.D.V.,PF) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
05/21/2025 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
Injection, acyclovir, 5 mg
|
⇄
|
63323-0325-14
ACYCLOVIR 500 MG/10 ML VIAL
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IJ |
| Billing Units |
ML |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
63323-0325-20
ACYCLOVIR SODIUM (S.D.V.,PF) 50 MG/ML
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
06/16/2025 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
Injection, acyclovir, 5 mg
|
⇄
|
63323-0325-24
ACYCLOVIR 1,000 MG/20 ML VIAL
|
| Detail Information |
| Relationship Start Date |
01/01/2006 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IJ |
| Billing Units |
ML |
|
|
|
J0133
Injection, acyclovir, 5 mg
|
⇄
|
63323-0325-41
ACYCLOVIR 500 MG/10 ML VIAL
|
| Detail Information |
| Relationship Start Date |
01/01/2022 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
Injection, acyclovir, 5 mg
|
⇄
|
63323-0325-43
ACYCLOVIR 1,000 MG/20 ML VI
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
63370-0007-25
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
1/1/2006 |
| Relationship End Date |
5/31/2013 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
63370-0007-35
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
1/1/2006 |
| Relationship End Date |
5/31/2013 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
63370-0007-50
ACYCLOVIR (U.S.P.)
|
| Detail Information |
| Relationship Start Date |
1/1/2006 |
| Relationship End Date |
5/31/2013 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
BO |
| Route Of Administration |
NA |
| Billing Units |
GM |
|
|
|
J0133
Injection, acyclovir, 5 mg
|
⇄
|
65219-0622-02
ACYCLOVIR 500 MG/10 ML VIAL
|
| Detail Information |
| Relationship Start Date |
06/11/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
65219-0622-10
ACYCLOVIR SODIUM 50 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
05/22/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
Injection, acyclovir, 5 mg
|
⇄
|
65219-0624-04
ACYCLOVIR 1,000 MG/20 ML VIAL
|
| Detail Information |
| Relationship Start Date |
07/07/2025 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
65219-0624-20
ACYCLOVIR SODIUM SDV 50 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
06/17/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
68382-0048-10
ACYCLOVIR SODIUM (10X10ML;SDV,LATEX-FREE) 50 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
12/21/2020 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
68382-0049-10
ACYCLOVIR SODIUM (10X20ML;SDV,LATEX-FREE) 50 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
12/21/2020 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
20 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
INJECTION, ACYCLOVIR, 5 MG
|
⇄
|
70436-0030-82
ACYCLOVIR SODIUM (SDV,LATEX-FREE) 50 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/08/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J0133
Acyclovir injection
|
⇄
|
55150-0154-10
Acyclovir Sodium
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0133
Acyclovir injection
|
⇄
|
55150-0155-20
Acyclovir Sodium
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0133
Acyclovir injection
|
⇄
|
63323-0325-10
Acyclovir Sodium
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0133
Acyclovir injection
|
⇄
|
63323-0325-14
Acyclovir Sodium
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0133
Acyclovir injection
|
⇄
|
63323-0325-20
Acyclovir Sodium
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0133
Acyclovir injection
|
⇄
|
63323-0325-24
Acyclovir Sodium
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0133
Acyclovir injection
|
⇄
|
65219-0622-10
Acyclovir Sodium
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0133
Acyclovir injection
|
⇄
|
65219-0624-20
Acyclovir Sodium
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0133
Acyclovir injection
|
⇄
|
70436-0030-82
Acyclovir Sodium
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|